U.S. Pathology and Laboratory Society Leadership Approves Joint NKF-ASN Task Force Recommendation to Use New Race-Free Equations to Diagnose Kidney Disease
NEW YORK, February 11, 2022 /PRNewswire/ — The leadership of the Pathology and Laboratory Society of the United States has approved the recommendation of the joint task force of the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) to use a new race-free equation for diagnosing kidney disease, also known as chronic kidney disease. Serum creatinine with estimated glomerular filtration rate (eGFRcr) is frequently measured and reported by United States clinical laboratories. This test is included in the Basic Metabolic, Complete Metabolic, Renal Function, and Renal Profile panels.1 eGFRcr and urinary albumin to creatinine ratio (uACR) are currently the primary tests used in clinical practice to assess kidney function, diagnose kidney failure, determine the severity of kidney failure, and monitor progression. eGFRcr is also used to inform treatment decisions, including drug dosing, timing of referral to nephrology, and preparation for kidney replacement therapies.
The leadership of the Pathology and Laboratory Society of the United States approves new race-free equations for diagnosing kidney disease!
More than 37 million adults in the United States have kidney disease. Of these, nearly 90% do not know they have it. A disproportionate number of people living with kidney disease belong to groups that routinely face health disparities and inequities in health care delivery, including Black or African American, Hispanic or Latinos, Native Americans or Alaska Natives, Asian Americans, and Native Hawaiians or other Pacific Islanders.
The two most commonly used equations for calculating eGFRcr in United States, the Modification of Diet in Renal Disease (MDRD) study, and the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equations, include a race coefficient. Because race is a subjective social construct, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a task force in 2020 to reevaluate the inclusion of race in the diagnosis of kidney disease in the United States. United. The NKF-ASN task force used a holistic approach incorporating input from the medical community and patients to identify an approach that balances social justice with scientific rigor.
The final report of the NKF-ASN working group recommends:
- Using the CKD-EPI 2021 eGFR creatinine equation to calculate eGFRcr in adults.2.3 This new equation is recommended because a race coefficient is not included in its calculation and report. The CKD-EPI 2021 eGFR creatinine equation has included diversity in its development and does not disproportionately affect any group.3
- National efforts are also underway to facilitate the increased, routine and timely use of cystatin C (CPT 82610), particularly to further assess eGFR in adults at risk of or with chronic kidney disease, or in people with abnormally high or low muscle mass. . CKD-EPI 2021 eGFR using creatinine and cystatin C (eGFRcr-cys) is more accurate, approximates measured GFR more closely, and supports better clinical decisions than either marker alone.2.3
Laboratories across the country are striving to employ a consistent and standardized approach to estimating GFR to improve screening tests for kidney disease. Together, the laboratory organizations below endorse the national implementation of the CKD-EPI 2021 creatinine and creatinine-cystatin C equations for estimating glomerular filtration rate.
Academy of Clinical Laboratory Physicians
Clinical laboratory management
American Association of Clinical Chemistry
College of American Pathologists (CAP)
American Society for Clinical Pathology
Independent National Laboratory
Association of Pathology Chairs (APC)
Society of American Federated Physicians
- Choosing Wisely, an initiative of the ABIM Foundation. American Society of Clinical Pathology. Recommendation for chronic renal failure
Test. 2018. at bit.ly/2SFSz3u
- Delgado C, Baweja M, Crews DC, et al. A unifying approach for estimating the GFR: recommendations of the NKF-ASN working group on
Reassessing the inclusion of race in the diagnosis of kidney disease. American Journal of Kidney Disease. DOI: 10.1053/j.ajkd.2021.08.003.
- Inker LA, Eneanya ND, Coresh J, et al. New equations based on creatinine and cystatin C to estimate race-free GFR. New England Journal of
Medicine 2021. DOI: 10.1056/NEJMoa2102953.
About Kidney Disease
In United States, an estimated 37 million adults suffer from kidney failure, also known as chronic kidney disease (CKD), and about 90% of them are unaware they have it. 1 in 3 adults in the United States is at risk for kidney disease. Risk factors for kidney disease include: diabetes, high blood pressure, heart disease, obesity, and family history. People of Black/African American, Hispanic/Latino, Native American/Alaska Native, Asian American, or Hawaiian/Other Pacific Islander ancestry are at increased risk of developing the disease. Blacks/African Americans are more than 3 times more likely than whites to have kidney failure. Hispanics/Latinos are 1.3 times more likely than non-Hispanics to have kidney failure.
About the National Kidney Foundation
The National Kidney Foundation (NKF) is the largest, most comprehensive, and oldest patient-centered organization dedicated to the awareness, prevention, and treatment of kidney disease in the United States. For more information about the NKF, visit www.kidney.org.
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SOURCE National Kidney Foundation